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Wong GM, McCray A, Hom K, Teti S, Cohen NT, Gaillard WD, Oluigbo CO. Outcomes of stereoelectroencephalography following failed epilepsy surgery in children. Childs Nerv Syst 2024; 40:2471-2482. [PMID: 38652142 DOI: 10.1007/s00381-024-06420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Stereoelectroencephalography (SEEG) is valuable for delineating the seizure onset zone (SOZ) in pharmacoresistant epilepsy when non-invasive presurgical techniques are inconclusive. Secondary epilepsy surgery after initial failure is challenging and there is limited research on SEEG following failed epilepsy surgery in children. OBJECTIVE The objective of this manuscript is to present the outcomes of children who underwent SEEG after failed epilepsy surgery. METHODS In this single-institution retrospective study, demographics, previous surgery data, SEEG characteristics, management, and follow-up were analyzed for pediatric patients who underwent SEEG after unsuccessful epilepsy surgery between August 2016 and February 2023. RESULTS Fifty three patients underwent SEEG investigation during this period. Of this, 13 patients were identified who had unsuccessful initial epilepsy surgery (24%). Of these 13 patients, six patients (46%) experienced unsuccessful resective epilepsy surgery that targeted the temporal lobe, six patients (46%) underwent surgery involving the frontal lobe, and one patient (8%) had laser interstitial thermal therapy (LITT) of the right insula. SEEG in two thirds of patients (4/6) with initial failed temporal resections revealed expanded SOZ to include the insula. All 13 patients (100%) had a subsequent surgery after SEEG which was either LITT (54%) or surgical resection (46%). After the subsequent surgery, a favorable outcome (Engel class I/II) was achieved by eight patients (62%), while five patients experienced an unfavorable outcome (Engel class III/IV, 38%). Of the six patients with secondary surgical resection, four patients (67%) had favorable outcomes, while of the seven patients with LITT, two patients (29%) had favorable outcomes (Engel I/II). Average follow-up after the subsequent surgery was 37 months ±23 months. CONCLUSION SEEG following initial failed resective epilepsy surgery may help guide next steps at identifying residual epileptogenic cortex and is associated with favorable seizure control outcomes.
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Affiliation(s)
- Georgia M Wong
- Department of Neurological Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Ashley McCray
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Kara Hom
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
| | - Saige Teti
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA
| | - Nathan T Cohen
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - William D Gaillard
- Department of Neurology, George Washington University School of Medicine, Washington, DC, USA
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Hospital, Washington, DC, 20012, USA.
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Andrade Machado R, Narayan SL, Norton NB, Javarayee P, Kim I, Lew SM. Temporal lobe epilepsy page: Role of temporal lobe structures and subjacent pathology in the intracranial ictal onset pattern in pediatric patients with temporal lobe epilepsy: A stereo-electroencephalogram analysis. Epilepsy Behav 2024; 159:109967. [PMID: 39068855 DOI: 10.1016/j.yebeh.2024.109967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/17/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To determine the intracranial ictal onset and early spread patterns in pediatric patients with Temporal lobe epilepsy and its possible association with histopathology, temporal structure involved, mesial structural pathology, and possible implication in postsurgical outcome. METHODS A descriptive, retrospective, cross-sectional study was carried out in a group of children from Children's Wisconsin between 2016 and 2022. RESULTS This study showed a strong association between ictal onset patterns and underlying histology (p < 0.05). Low-Frequency High Amplitude periodic spikes were seen only in patients with HS (20.6 %). A strong statistically significant association was found between different ictal onset patterns and the temporal lobe structure involved in the ictal onset (p < 0.001). Seizures with ictal onset consisting of Slow Potential Shift with superimposed Low Voltage Fast Activity arise from the Inferior Temporal Lobe or Middle Temporal Gyrus in a more significant proportion of seizures than those that originated from mesial temporal structures (Difference of proportion; p < 0.05). Low Voltage Fast Activity periodic spikes as an ictal pattern were seen in a patient with seizures arising outside the mesial temporal structure. The most frequent early spread pattern observed was Low Voltage Fast Activity (89.4 %); this pattern did not depend on the type of mesial structure pathology. Ictal onset patterns were associated with postsurgical outcomes (p < 0.001). The ictal onset pattern depends on the histopathology in the ictal onset zone and the temporal lobe structure involved in the ictal onset (p = 0.001). CONCLUSIONS Intracranial ictal onset patterns in TEMPORAL LOBE EPILEPSY depend on underlying histology and the temporal lobe structure involved in its onset.
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Affiliation(s)
- Rene Andrade Machado
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Shruti L Narayan
- Case Western Reserve University, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Natalie B Norton
- St. Norbert College, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Pradeep Javarayee
- Children's Wisconsin, Neurology Department, Division of Pediatric Neurology. Medical College of Wisconsin, Milwaukee, WI, United States
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sean M Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Sobstyl M, Kowalska M, Konopko M, Wierzbicka A, Karamon K, Nagańska E. Deep brain stimulation of the subiculum in the treatment for refractory temporal lobe epilepsy due to unilateral mesial temporal lobe sclerosis. Epilepsy Behav Rep 2024; 27:100677. [PMID: 38845792 PMCID: PMC11153886 DOI: 10.1016/j.ebr.2024.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS.
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Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Magdalena Kowalska
- Department of Neurology and Epileptology, Independent Public Clinical Hospital, Medical Center for Postgraduate Education, Czerniakowska 231 Street, 00-416 Warsaw, Poland
| | - Magdalena Konopko
- 1st Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Aleksandra Wierzbicka
- Department of Neurophysiology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Karol Karamon
- Department of Radiology, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland
| | - Ewa Nagańska
- Department of Neurology and Epileptology, Independent Public Clinical Hospital, Medical Center for Postgraduate Education, Czerniakowska 231 Street, 00-416 Warsaw, Poland
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Zhou DJ, Gumenyuk V, Taraschenko O, Grobelny BT, Stufflebeam SM, Peled N. Visualization of the Spatiotemporal Propagation of Interictal Spikes in Temporal Lobe Epilepsy: A MEG Pilot Study. Brain Topogr 2024; 37:116-125. [PMID: 37966675 DOI: 10.1007/s10548-023-01017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Magnetoencephalography (MEG) is clinically used to localize interictal spikes in discrete brain areas of epilepsy patients through the equivalent current dipole (ECD) method, but does not account for the temporal dynamics of spike activity. Recent studies found that interictal spike propagation beyond the temporal lobe may be associated with worse postsurgical outcomes, but studies using whole-brain data such as in MEG remain limited. In this pilot study, we developed a tool that visualizes the spatiotemporal dynamics of interictal MEG spikes normalized to spike-free sleep activity to assess their onset and propagation patterns in patients with temporal lobe epilepsy (TLE). We extracted interictal source data containing focal epileptiform activity in awake and asleep states from seven patients whose MEG ECD clusters localized to the temporal lobe and normalized the data against spike-free sleep recordings. We calculated the normalized activity over time per cortical label, confirmed maximal activity at onset, and mapped the activity over a 10 ms interval onto each patient's brain using a custom-built Multi-Modal Visualization Tool. The onset of activity in all patients appeared near the clinically determined epileptogenic zone. By 10 ms, four of the patients had propagated source activity restricted to within the temporal lobe, and three had propagated source activity spread to extratemporal regions. Using this tool, we show that noninvasively identifying the onset and propagation of interictal spike activity in MEG can be achieved, which may help provide further insight into epileptic networks and guide surgical planning and interventions in patients with TLE.
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Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Valentina Gumenyuk
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bartosz T Grobelny
- Department of Neurosurgery, Saint Luke's Health System of Kansas City, Kansas City, MO, USA
| | - Steven M Stufflebeam
- MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Noam Peled
- MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
- Harvard Medical School, Cambridge, MA, USA.
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Zhang D, Tong Y, Hu Z, Wu G, He J, Fan Z, Wu D, Feng R, Lang L, Hu J, Chen L, Yu J. Deep learning and radiomics based automatic diagnosis of hippocampal sclerosis. Int J Neurosci 2023; 133:947-958. [PMID: 34963424 DOI: 10.1080/00207454.2021.2018428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/23/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
Accurate and rapid segmentation of the hippocampus can help doctors perform intractable temporal lobe epilepsy (TLE) preoperative evaluations to identify good surgical candidates. This study aims to establish a radiomics system for the automatic diagnosis of hippocampal sclerosis with the help of machine learning. A total of 240 cases were analysed to develop a diagnostic model. First, an automatic hippocampal segmentation process was established that exploits a priori knowledge of the relatively fixed location of the hippocampus in brain partitions, as well as a deep-learning segmentation network based on an Attention U-net. Then, we extracted 527 radiomics features from each side of the segmented hippocampus. The iterative sparse representation based on feature selection and a support vector machine classifier were finally used to establish the diagnostic model of hippocampal sclerosis. The diagnostic model consists of two consecutive steps: distinguish hippocampal sclerosis (HS) from normal control (NC) and detect whether the HS is located on the left or right side. When the automatic diagnosis model identified HS and NC, the sensitivity and specificity reached 0.941 and 0.917 in the 10-fold cross-validation set and 0.920 and 0.909 in the independent testing set. When the diagnostic model detected HS lateralization, the sensitivity and specificity reached 0.923 and 0.920 in cross-validation and 0.909 and 0.929 in independent testing. Our results show that the developed radiomics model can help detect TLE patients with hippocampal sclerosis and has the potential to simplify preoperative evaluations and select surgical candidates.
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Affiliation(s)
- Dachuan Zhang
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yusheng Tong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Zhaoyu Hu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Guoqing Wu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Juanjuan He
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Zhen Fan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Dongyan Wu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Rui Feng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Liqin Lang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai Neurosurgical Clinical Center, Shanghai, China
| | - Jinhua Yu
- AI Lab of Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Medical Imaging, Computing and Computer Assisted Intervention, Shanghai, China
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Cheval M, Rodrigo S, Taussig D, Caillé F, Petrescu AM, Bottlaender M, Tournier N, Besson FL, Leroy C, Bouilleret V. [ 18F]DPA-714 PET Imaging in the Presurgical Evaluation of Patients With Drug-Resistant Focal Epilepsy. Neurology 2023; 101:e1893-e1904. [PMID: 37748889 PMCID: PMC10663012 DOI: 10.1212/wnl.0000000000207811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Translocator protein 18 kDa (TSPO) PET imaging is used to monitor glial activation. Recent studies have proposed TSPO PET as a marker of the epileptogenic zone (EZ) in drug-resistant focal epilepsy (DRFE). This study aims to assess the contributions of TSPO imaging using [18F]DPA-714 PET and [18F]FDG PET for localizing the EZ during presurgical assessment of DRFE, when phase 1 presurgical assessment does not provide enough information. METHODS We compared [18F]FDG and [18F]DPA-714 PET images of 23 patients who had undergone a phase 1 presurgical assessment, using qualitative visual analysis and quantitative analysis, at both the voxel and the regional levels. PET abnormalities (increase in binding for [18F]DPA-714 vs decrease in binding for [18F]FDG) were compared with clinical hypotheses concerning the localization of the EZ based on phase 1 presurgical assessment. The additional value of [18F]DPA-714 PET imaging to [18F]FDG for refining the localization of the EZ was assessed. To strengthen the visual analysis, [18F]DPA-714 PET imaging was also reviewed by 2 experienced clinicians blind to the EZ location. RESULTS The study included 23 patients. Visual analysis of [18F]DPA-714 PET was significantly more accurate than [18F]FDG PET to both, show anomalies (95.7% vs 56.5%, p = 0.022), and provide additional information to refine the EZ localization (65.2% vs 17.4%, p = 0.019). All 10 patients with normal [18F]FDG PET had anomalies when using [18F]DPA-714 PET. The additional value of [18F]DPA-714 PET seemed to be greater in patients with normal brain MRI or with neocortical EZ (especially if insula is involved). Regional analysis of [18F]DPA-714 and [18F]FDG PET provided similar results. However, using voxel-wise analysis, [18F]DPA-714 was more effective than [18F]FDG for unveiling clusters whose localization was more often consistent with the EZ hypothesis (87.0% vs 39.1%, p = 0.019). Nonrelevant bindings were seen in 14 of 23 patients in visual analysis and 9 patients of 23 patients in voxel-wise analysis. DISCUSSION [18F]DPA-714 PET imaging provides valuable information for presurgical assessments of patients with DRFE. TSPO PET could become an additional tool to help to the localization of the EZ, especially in patients with negative [18F]FDG PET. TRIAL REGISTRATION INFORMATION Eudract 2017-003381-27. Inclusion of the first patient: September 24, 2018. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence on the utility of [18F]DPA-714 PET compared with [18F]FDG PET in identifying the epileptic zone in patients undergoing phase 1 presurgical evaluation for intractable epilepsy.
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Affiliation(s)
- Margaux Cheval
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France.
| | - Sebastian Rodrigo
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Delphine Taussig
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Fabien Caillé
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Ana Maria Petrescu
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Michel Bottlaender
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Nicolas Tournier
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Florent L Besson
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Claire Leroy
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
| | - Viviane Bouilleret
- From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France
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Piper RJ, Dasgupta D, Eriksson MH, Ripart M, Moosa A, Chari A, Seunarine KK, Clark CA, Duncan JS, Carmichael DW, Tisdall MM, Baldeweg T. Extent of piriform cortex resection in children with temporal lobe epilepsy. Ann Clin Transl Neurol 2023; 10:1613-1622. [PMID: 37475156 PMCID: PMC10502684 DOI: 10.1002/acn3.51852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE A greater extent of resection of the temporal portion of the piriform cortex (PC) has been shown to be associated with higher likelihood of seizure freedom in adults undergoing anterior temporal lobe resection (ATLR) for drug-resistant temporal lobe epilepsy (TLE). There have been no such studies in children, therefore this study aimed to investigate this association in a pediatric cohort. METHODS A retrospective, neuroimaging cohort study of children with TLE who underwent ATLR between 2012 and 2021 was undertaken. The PC, hippocampal and amygdala volumes were measured on the preoperative and postoperative T1-weighted MRI. Using these volumes, the extent of resection per region was compared between the seizure-free and not seizure-free groups. RESULTS In 50 children (median age 9.5 years) there was no significant difference between the extent of resection of the temporal PC in the seizure-free (median = 50%, n = 33/50) versus not seizure-free (median = 40%, n = 17/50) groups (p = 0.26). In a sub-group of 19 with ipsilateral hippocampal atrophy (quantitatively defined by ipsilateral-to-contralateral asymmetry), the median extent of temporal PC resection was greater in children who were seizure-free (53%) versus those not seizure-free (19%) (p = 0.009). INTERPRETATION This is the first study demonstrating that, in children with TLE and hippocampal atrophy, more extensive temporal PC resection is associated with a greater chance of seizure freedom-compatible with an adult series in which 85% of patients had hippocampal sclerosis. In a combined group of children with and without hippocampal atrophy, the extent of PC resection was not associated with seizure outcome, suggesting different epileptogenic networks within this cohort.
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Affiliation(s)
- Rory J. Piper
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Department of NeurosurgeryGreat Ormond Street HospitalLondonUK
| | - Debayan Dasgupta
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Victor Horsley Department of NeurosurgeryNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Maria H. Eriksson
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- NeuropsychologyGreat Ormond Street Hospital NHS TrustLondonUK
- Department of NeurologyGreat Ormond Street Hospital NHS TrustLondonUK
| | - Mathilde Ripart
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Almira Moosa
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Aswin Chari
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Department of NeurosurgeryGreat Ormond Street HospitalLondonUK
| | - Kiran K. Seunarine
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Chris A. Clark
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | | | - Martin M. Tisdall
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
- Department of NeurosurgeryGreat Ormond Street HospitalLondonUK
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
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8
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Chen JS, Lamoureux AA, Shlobin NA, Elkaim LM, Wang A, Ibrahim GM, Obaid S, Harroud A, Guadagno E, Dimentberg E, Bouthillier A, Bernhardt BC, Nguyen DK, Fallah A, Weil AG. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: A systematic review and individual participant data meta-analysis. Epilepsia 2023; 64:1957-1974. [PMID: 36824029 DOI: 10.1111/epi.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug-resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta-analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms "MR-guided ablation therapy" and "epilepsy". Multivariable mixed-effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow-up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure-free at last follow-up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p < .001) and mesial temporal sclerosis/atrophy (MTS/A; OR = 2.21, p = .011) were independently associated with greater odds of seizure freedom at last follow-up. Operative complications occurred in 28 (8.5%) of 330 patients and were independently associated with extratemporal ablations (OR = 5.40, p = .012) and nonlesional MRI studies (OR = 3.25, p = .017). Postoperative neurological deficits were observed in 53 (15.1%) of 352 patients and were independently predicted by hypothalamic hamartoma etiology (OR = 5.93, p = .006) and invasive electroencephalographic monitoring (OR = 4.83, p = .003). Overall, MRgLITT is particularly effective in treating patients with well-circumscribed lesional DRE, such as CCM and MTS/A, but less effective in nonlesional cases or lesional cases with a more diffuse epileptogenic network associated with generalized seizures. This study identifies independent predictors of seizure freedom and complications following MRgLITT that may help further guide patient selection.
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Affiliation(s)
- Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Audrey-Anne Lamoureux
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lior M Elkaim
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sami Obaid
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Adil Harroud
- Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Evan Dimentberg
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alain Bouthillier
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Dang K Nguyen
- Division of Neurology, University of Montreal Medical Center, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
- Division of Neurosurgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
- Brain and Child Development Axis, Sainte Justine Research Center, Montreal, Quebec, Canada
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9
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Hamdi H, Kishk N, Shamloul R, Moawad MK, Baghdadi M, Rizkallah M, Nawito A, Mohammad ME, Nazmi H, Nasr YM, Waly SH, Elshahat M, Magdy R, Othman AS, Nafea H, Fouad AM, Elantably I, Rizk H, Elsayyad E, Morsy AA. Resective epilepsy surgery in a limited-resource settings: A cohort from a multi-disciplinary epilepsy team in a developing country. Surg Neurol Int 2023; 14:240. [PMID: 37560561 PMCID: PMC10408623 DOI: 10.25259/sni_1081_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Multidisciplinary pre-surgical evaluation is vital for epilepsy surgery decision and outcomes. Resective epilepsy surgery with assisted monitoring is currently a standard treatment for focal drug resistant epilepsy (DRE). In resource-limited countries, lack of epilepsy surgery center is a huge challenge. We presented and illustrated how to create a multidisciplinary protocol with resource-limited settings in a developing country and epilepsy surgery outcome using brain mapping and monitoring techniques for ensuring satisfactory resection. METHODS We created multicentric incomplete but complementary units covering all epilepsy-related sub-specialties and covering a wide geographical area in our country. Then, we conducted a prospective and multicentric study with low resource settings on patients with focal DRE, who underwent resective epilepsy surgery and were followed up for at least 12 months and were evaluated for postoperative seizure outcome and complications if present. Preoperative comprehensive clinical, neurophysiological, neuropsychological, and radiological evaluations were performed by multidisciplinary epilepsy team. Intraoperative brain mapping including awake craniotomy and direct stimulation techniques, neurophysiological monitoring, and electrocorticography was carried out during surgical resection. RESULTS The study included 47 patients (18 females and 29 males) with mean age 20.4 ± 10.02 years. Twenty-two (46.8%) patients were temporal epilepsy while 25 (53.2%) were extra-temporal epilepsy. The epilepsy surgery outcome at the last follow up was Engel Class I (seizure free) in 35 (74.5%), Class II (almost seizure free) in 8 (17%), Class III (worthwhile improvement) in 3 (6.4%), and Class IV (no worthwhile improvement) in 1 patient (2.1%). CONCLUSION With low resource settings and lack of single fully equipped epilepsy center, favorable outcomes after resective surgery in patients with focal DRE could be achieved using careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques.
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Affiliation(s)
- Hussein Hamdi
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nirmeen Kishk
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham Shamloul
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona K. Moawad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mina Rizkallah
- Department of Radiology, Ministry of Health, Cairo, Egypt
| | - Amani Nawito
- Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hatem Nazmi
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Yasser Mohamed Nasr
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Salwa Hassan Waly
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Mo’men Elshahat
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rehab Magdy
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alshimaa S. Othman
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Nafea
- Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amro M Fouad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ismail Elantably
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Haytham Rizk
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Enas Elsayyad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A. Morsy
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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10
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Tsalouchidou PE, Zoellner JP, Kirscht A, Mueller CJ, Nimsky C, Schulze M, Hattingen E, Chatzis G, Freiman TM, Strzelczyk A, Fuest S, Menzler K, Rosenow F, Knake S. Temporal encephaloceles and coexisting epileptogenic lesions. Epilepsia Open 2023; 8:113-124. [PMID: 36408781 PMCID: PMC9977755 DOI: 10.1002/epi4.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was performed to identify coexisting structural lesions in patients with epilepsy and known temporal encephaloceles (TEs). METHODS Forty-seven structural magnetic resonance imaging (MRI) scans of patients with epilepsy and radiologically diagnosed TEs were retrospectively reviewed visually and using an automated postprocessing software, the Morphometric Analysis Program v2018 (MAP18), to depict additional subtle, potentially epileptogenic lesions in the 3D T1-weighted MRI data. All imaging findings were evaluated in the context of clinical and electroencephalographical findings. RESULTS The study population consisted of 47 epilepsy patients (38.3% female, n = 18). The median age at the time of the scan was 40 years (range 12-81 years). Twenty-one out of 47 MRI scans (44.7%) showed coexisting lesions in the initial MRI evaluation; in 38.3% (n = 18) of patients, those lesions were considered probably epileptogenic. After postprocessing, probable epileptogenic lesions were identified in 53.2% (n = 25) of patients. Malformations of cortical development had initially been reported in 17.0% (n = 8) of patients with TEs, which increased to 38.3% (n = 18) after postprocessing. TEs and other epileptogenic lesions were considered equally epileptogenic in 21.3% (n = 10) of the cases in the initial MR reports and 25.5% (n = 12) of the cases after postprocessing. SIGNIFICANCE Temporal encephaloceles are a potential cause of MRI-negative temporal lobe epilepsy. According to our data, TEs can occur with other lesions, suggesting that increased awareness is also required in patients with lesional epilepsy. TEs may not always be epileptogenic; hence, their occurrence with other structural pathologies may influence the presurgical evaluation and surgical approach. Finally, TEs can be associated with malformations of cortical development, which may indicate a common developmental etiology of those lesions.
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Affiliation(s)
| | - Johann Philipp Zoellner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | - Annika Kirscht
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christina Julia Mueller
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps University Marburg, Marburg, Germany
| | - Maximilian Schulze
- Division of Neuroradiology, Philipps University Marburg, Marburg, Germany
| | - Elke Hattingen
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany.,Department of Neuroradiology, Goethe University, Frankfurt, Germany
| | - Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Marburg, Germany
| | | | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | - Sven Fuest
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Katja Menzler
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany.,Core Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany.,Core Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
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11
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Goel K, Pek V, Shlobin NA, Chen JS, Wang A, Ibrahim GM, Hadjinicolaou A, Roessler K, Dudley RW, Nguyen DK, El-Tahry R, Fallah A, Weil AG. Clinical utility of intraoperative electrocorticography for epilepsy surgery: A systematic review and meta-analysis. Epilepsia 2023; 64:253-265. [PMID: 36404579 DOI: 10.1111/epi.17472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
Despite the widespread use of intraoperative electrocorticography (iECoG) during resective epilepsy surgery, there are conflicting data on its overall efficacy and inability to predict benefit per pathology. Given the heterogeneity of iECoG use in resective epilepsy surgery, it is important to assess the utility of interictal-based iECoG. This individual patient data (IPD) meta-analysis seeks to identify the benefit of iECoG during resective epilepsy surgery in achieving seizure freedom for various pathologies. Embase, Scopus, and PubMed were searched from inception to January 31, 2021 using the following terms: "ecog", "electrocorticography", and "epilepsy". Articles were included if they reported seizure freedom at ≥12-month follow-up in cohorts with and without iECoG for epilepsy surgery. Non-English articles, noncomparative iECoG cohorts, and studies with <10% iECoG use were excluded. This meta-analysis followed the PRISMA 2020 guidelines. The primary outcome was seizure freedom at last follow-up and time to seizure recurrence, if applicable. Forest plots with random effects modeling assessed the relationship between iECoG use and seizure freedom. Cox regression of IPD was performed to identify predictors of longer duration of seizure freedom. Kaplan-Meier curves with log-rank test were created to visualize differences in time to seizure recurrence. Of 7504 articles identified, 18 were included for study-level analysis. iECoG was not associated with higher seizure freedom at the study level (relative risk = 1.09, 95% confidence interval [CI] = 0.96-1.23, p = .19, I2 = 64%), but on IPD (n = 7 studies, 231 patients) iECoG use was independently associated with more favorable seizure outcomes (hazard ratio = 0.47, 95% CI = .23-.95, p = .037). In Kaplan-Meier analysis of specific pathologies, iECoG use was significantly associated with longer seizure freedom only for focal cortical dysplasia (FCD; p < .001) etiology. Number needed to treat for iECoG was 8.8, and for iECoG in FCD it was 4.7. We show iECoG seizure freedom is not achieved uniformly across centers. iECoG is particularly beneficial for FCD etiology in improving seizure freedom.
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Affiliation(s)
- Keshav Goel
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Valérie Pek
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jia-Shu Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew Wang
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, Los Angeles, California, USA
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aristides Hadjinicolaou
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Roy W Dudley
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Dang K Nguyen
- Department of Neurology, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Riëm El-Tahry
- Saint Luc University Hospital, Brussels, Belgium
- Institute of Neuroscience, Neurology pole, Catholic University of Louvain, Brussels, Belgium
| | - Aria Fallah
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander G Weil
- Brain and Development Research Axis, Sainte-Justine Research Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
- Department of Neuroscience, University of Montreal, Montreal, Quebec, Canada
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12
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Coorg R, Seto ES. Invasive Epilepsy Monitoring: The Switch from Subdural Electrodes to Stereoelectroencephalography. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractStereoelectroencephalography (SEEG) has experienced an explosion in use due to a shifting understanding of epileptic networks and wider application of minimally invasive epilepsy surgery techniques. Both subdural electrode (SDE) monitoring and SEEG serve important roles in defining the epileptogenic zone, limiting functional deficits, and formulating the most effective surgical plan. Strengths of SEEG include the ability to sample difficult to reach, deep structures of the brain without a craniotomy and without disrupting the dura. SEEG is complementary to minimally invasive epilepsy treatment options and may reduce the treatment gap in patients who are hesitant about craniotomy and surgical resection. Understanding the strengths and limitations of SDE monitoring and SEEG allows epileptologists to choose the best modality of invasive monitoring for each patient living with drug-resistant seizures.
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Affiliation(s)
- Rohini Coorg
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
| | - Elaine S. Seto
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
- Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas, United States
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13
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Perucca P, Stanley K, Harris N, McIntosh AM, Asadi-Pooya AA, Mikati MA, Andrade DM, Dugan P, Depondt C, Choi H, Heinzen EL, Cavalleri GL, Buono RJ, Devinsky O, Sperling MR, Berkovic SF, Delanty N, Goldstein DB, O'Brien TJ. Rare Genetic Variation and Outcome of Surgery for Mesial Temporal Lobe Epilepsy. Ann Neurol 2022; 93:752-761. [PMID: 36534060 DOI: 10.1002/ana.26581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Genetic factors have long been debated as a cause of failure of surgery for mesial temporal lobe epilepsy (MTLE). We investigated whether rare genetic variation influences seizure outcomes of MTLE surgery. METHODS We performed an international, multicenter, whole exome sequencing study of patients who underwent surgery for drug-resistant, unilateral MTLE with normal magnetic resonance imaging (MRI) or MRI evidence of hippocampal sclerosis and ≥2-year postsurgical follow-up. Patients with either sustained seizure freedom (favorable outcome) or ongoing uncontrolled seizures since surgery (unfavorable outcome) were included. Exomes of controls without epilepsy were also included. Gene set burden analyses were carried out to identify genes with significant enrichment of rare deleterious variants in patients compared to controls. RESULTS Nine centers from 3 continents contributed 206 patients operated for drug-resistant unilateral MTLE, of whom 196 (149 with favorable outcome and 47 with unfavorable outcome) were included after stringent quality control. Compared to 8,718 controls, MTLE cases carried a higher burden of ultrarare missense variants in constrained genes that are intolerant to loss-of-function (LoF) variants (odds ratio [OR] = 2.6, 95% confidence interval [CI] = 1.9-3.5, p = 1.3E-09) and in genes encoding voltage-gated cation channels (OR = 2.4, 95% CI = 1.4-3.8, p = 2.7E-04). Proportions of subjects with such variants were comparable between patients with favorable outcome and those with unfavorable outcome, with no significant between-group differences. INTERPRETATION Rare variation contributes to the genetic architecture of MTLE, but does not appear to have a major role in failure of MTLE surgery. These findings can be incorporated into presurgical decision-making and counseling. ANN NEUROL 2022.
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Affiliation(s)
- Piero Perucca
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Kate Stanley
- Institute for Genomic Medicine, Columbia University, New York, New York, USA
| | - Natasha Harris
- Institute for Genomic Medicine, Columbia University, New York, New York, USA
| | - Anne M McIntosh
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | | | - Patricia Dugan
- Department of Neurology, New York University Langone Medical Center, New York, New York, USA
| | - Chantal Depondt
- Department of Neurology, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Hyunmi Choi
- Department of Neurology, Columbia University, New York, New York, USA
| | - Erin L Heinzen
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gianpiero L Cavalleri
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Russell J Buono
- Department of Biomedical Science, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Orrin Devinsky
- Department of Neurology, New York University Langone Medical Center, New York, New York, USA
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Norman Delanty
- FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - David B Goldstein
- Institute for Genomic Medicine, Columbia University, New York, New York, USA
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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14
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DeFelipe J, DeFelipe-Oroquieta J, Furcila D, Muñoz-Alegre M, Maestú F, Sola RG, Blázquez-Llorca L, Armañanzas R, Kastanaskaute A, Alonso-Nanclares L, Rockland KS, Arellano JI. Neuroanatomical and psychological considerations in temporal lobe epilepsy. Front Neuroanat 2022; 16:995286. [PMID: 36590377 PMCID: PMC9794593 DOI: 10.3389/fnana.2022.995286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/11/2022] [Indexed: 01/03/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy and is associated with a variety of structural and psychological alterations. Recently, there has been renewed interest in using brain tissue resected during epilepsy surgery, in particular 'non-epileptic' brain samples with normal histology that can be found alongside epileptic tissue in the same epileptic patients - with the aim being to study the normal human brain organization using a variety of methods. An important limitation is that different medical characteristics of the patients may modify the brain tissue. Thus, to better determine how 'normal' the resected tissue is, it is fundamental to know certain clinical, anatomical and psychological characteristics of the patients. Unfortunately, this information is frequently not fully available for the patient from which the resected tissue has been obtained - or is not fully appreciated by the neuroscientists analyzing the brain samples, who are not necessarily experts in epilepsy. In order to present the full picture of TLE in a way that would be accessible to multiple communities (e.g., basic researchers in neuroscience, neurologists, neurosurgeons and psychologists), we have reviewed 34 TLE patients, who were selected due to the availability of detailed clinical, anatomical, and psychological information for each of the patients. Our aim was to convey the full complexity of the disorder, its putative anatomical substrates, and the wide range of individual variability, with a view toward: (1) emphasizing the importance of considering critical patient information when using brain samples for basic research and (2) gaining a better understanding of normal and abnormal brain functioning. In agreement with a large number of previous reports, this study (1) reinforces the notion of substantial individual variability among epileptic patients, and (2) highlights the common but overlooked psychopathological alterations that occur even in patients who become "seizure-free" after surgery. The first point is based on pre- and post-surgical comparisons of patients with hippocampal sclerosis and patients with normal-looking hippocampus in neuropsychological evaluations. The second emerges from our extensive battery of personality and projective tests, in a two-way comparison of these two types of patients with regard to pre- and post-surgical performance.
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Affiliation(s)
- Javier DeFelipe
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain,*Correspondence: Javier DeFelipe,
| | - Jesús DeFelipe-Oroquieta
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Facultad de Educación, Universidad Camilo José Cela, Madrid, Spain
| | - Diana Furcila
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mar Muñoz-Alegre
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Fernando Maestú
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain
| | - Rafael G. Sola
- Cátedra UAM de “Innovación en Neurocirugía”, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lidia Blázquez-Llorca
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Sección Departamental de Anatomía y Embriología, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Armañanzas
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain,Tecnun School of Engineering, Universidad de Navarra, Donostia-San Sebastian, Spain
| | - Asta Kastanaskaute
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Lidia Alonso-Nanclares
- Laboratorio Cajal de Circuitos Corticales, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Madrid, Spain,Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Kathleen S. Rockland
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | - Jon I. Arellano
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States
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15
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Kasa LW, Peters T, Mirsattari SM, Jurkiewicz MT, Khan AR, A M Haast R. The role of the temporal pole in temporal lobe epilepsy: A diffusion kurtosis imaging study. Neuroimage Clin 2022; 36:103201. [PMID: 36126518 PMCID: PMC9486670 DOI: 10.1016/j.nicl.2022.103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to evaluate the use of diffusion kurtosis imaging (DKI) to detect microstructural abnormalities within the temporal pole (TP) and its temporopolar cortex in temporal lobe epilepsy (TLE) patients. DKI quantitative maps were obtained from fourteen lesional TLE and ten non-lesional TLE patients, along with twenty-three healthy controls. Data collected included mean (MK); radial (RK) and axial kurtosis (AK); mean diffusivity (MD) and axonal water fraction (AWF). Automated fiber quantification (AFQ) was used to quantify DKI measurements along the inferior longitudinal (ILF) and uncinate fasciculus (Unc). ILF and Unc tract profiles were compared between groups and tested for correlation with disease duration. To characterize temporopolar cortex microstructure, DKI maps were sampled at varying depths from superficial white matter (WM) towards the pial surface. Patients were separated according to the temporal lobe ipsilateral to seizure onset and their AFQ results were used as input for statistical analyses. Significant differences were observed between lesional TLE and controls, towards the most temporopolar segment of ILF and Unc proximal to the TP within the ipsilateral temporal lobe in left TLE patients for MK, RK, AWF and MD. No significant changes were observed with DKI maps in the non-lesional TLE group. DKI measurements correlated with disease duration, mostly towards the temporopolar segments of the WM bundles. Stronger differences in MK, RK and AWF within the temporopolar cortex were observed in the lesional TLE and noticeable differences (except for MD) in non-lesional TLE groups compared to controls. This study demonstrates that DKI has potential to detect subtle microstructural alterations within the temporopolar segments of the ILF and Unc and the connected temporopolar cortex in TLE patients including non-lesional TLE subjects. This could aid our understanding of the extrahippocampal areas, more specifically the temporal pole role in seizure generation in TLE and might inform surgical planning, leading to better seizure outcomes.
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Affiliation(s)
- Loxlan W Kasa
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Terry Peters
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Michael T Jurkiewicz
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Ali R Khan
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Roy A M Haast
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, Ontario, Canada
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Jaafar N, Bhatt A, Eid A, Koubeissi MZ. The Temporal Lobe as a Symptomatogenic Zone in Medial Parietal Lobe Epilepsy. Front Neurol 2022; 13:804128. [PMID: 35370889 PMCID: PMC8965346 DOI: 10.3389/fneur.2022.804128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Some surgical failures after temporal lobe epilepsy surgery may be due to the presence of an extratemporal epileptogenic zone. Of particular interest is the medial parietal lobe due to its robust connectivity with mesial temporal structures. Seizures in that area may be clinically silent before propagating to the symptomatogenic temporal lobe. In this paper, we present an overview of the anatomical connectivity, semiology, radiology, electroencephalography, neuropsychology, and outcomes in medial parietal lobe epilepsy. We also present two illustrative cases of seizures originating from the precuneus and the posterior cingulate cortex. We conclude that the medial parietal lobe should be strongly considered for sampling by intracranial electrodes in individuals with nonlesional temporal lobe epilepsy, especially if scrutinizing the presurgical data produces discordant findings.
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Affiliation(s)
- Nadim Jaafar
- Department of Neurology, George Washington University, Washington, DC, United States
| | - Amar Bhatt
- Rush Medical College, Rush University, Chicago, IL, United States
| | - Alexandra Eid
- Department of Neurology, George Washington University, Washington, DC, United States
| | - Mohamad Z. Koubeissi
- Department of Neurology, George Washington University, Washington, DC, United States
- *Correspondence: Mohamad Z. Koubeissi
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17
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Satzer D, Esengul YT, Warnke PC, Issa NP, Nordli DR. SEEG in 3D: Interictal Source Localization From Intracerebral Recordings. Front Neurol 2022; 13:782880. [PMID: 35211078 PMCID: PMC8861202 DOI: 10.3389/fneur.2022.782880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereo-electroencephalography (SEEG) uses a three-dimensional configuration of depth electrodes to localize epileptiform activity, but traditional analysis of SEEG is spatially restricted to the point locations of the electrode contacts. Interpolation of brain activity between contacts might allow for three-dimensional representation of epileptiform activity and avoid pitfalls of SEEG interpretation. OBJECTIVE The goal of this study was to validate SEEG-based interictal source localization and assess the ability of this technique to monitor far-field activity in non-implanted brain regions. METHODS Interictal epileptiform discharges were identified on SEEG in 26 patients who underwent resection, ablation, or disconnection of the suspected epileptogenic zone. Dipoles without (free) and with (scan) gray matter restriction, and current density (sLORETA and SWARM methods), were calculated using a finite element head model. Source localization results were compared to the conventional irritative zone (IZ) and the surgical treatment volumes (TV) of seizure-free vs. non-seizure-free patients. RESULTS The median distance from dipole solutions to the nearest contact in the conventional IZ was 7 mm (interquartile range 4-15 mm for free dipoles and 4-14 mm for scan dipoles). The IZ modeled with SWARM predicted contacts within the conventional IZ with 83% (75-100%) sensitivity and 94% (88-100%) specificity. The proportion of current within the TV was greater in seizure-free patients (P = 0.04) and predicted surgical outcome with 45% sensitivity and 93% specificity. Dipole solutions and sLORETA results did not correlate with seizure outcome. Addition of scalp EEG led to more superficial modeled sources (P = 0.03) and negated the ability to predict seizure outcome (P = 0.23). Removal of near-field data from contacts within the TV resulted in smearing of the current distribution (P = 0.007) and precluded prediction of seizure freedom (P = 0.20). CONCLUSIONS Source localization accurately represented interictal discharges from SEEG. The proportion of current within the TV distinguished between seizure-free and non-seizure-free patients when near-field recordings were obtained from the surgical target. The high prevalence of deep sources in this cohort likely obscured any benefit of concurrent scalp EEG. SEEG-based interictal source localization is useful in illustrating and corroborating the epileptogenic zone. Additional techniques are needed to localize far-field epileptiform activity from non-implanted brain regions.
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Affiliation(s)
- David Satzer
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Yasar T Esengul
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Peter C Warnke
- Department of Neurosurgery, University of Chicago, Chicago, IL, United States
| | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Douglas R Nordli
- Section of Child Neurology, Department of Pediatrics, University of Chicago, Chicago, IL, United States
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18
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Insular Involvement in Cases of Epilepsy Surgery Failure. Brain Sci 2022; 12:brainsci12020125. [PMID: 35203889 PMCID: PMC8870364 DOI: 10.3390/brainsci12020125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Epilepsy surgery failure is not uncommon, with several explanations having been proposed. In this series, we detail cases of epilepsy surgery failure subsequently attributed to insular involvement. Methods: We retrospectively identified patients investigated at the epilepsy monitoring units of two Canadian tertiary care centers (2004–2020). Included patients were adults who had undergone epilepsy surgeries with recurrence of seizures post-operatively and who were subsequently determined to have an insular epileptogenic focus. Clinical, electrophysiological, neuroimaging, and surgical data were synthesized. Results: We present 14 patients who demonstrated insular epileptic activity post-surgery-failure as detected by intracranial EEG, MEG, or seizure improvement after insular resection. Seven patients had manifestations evoking possible insular involvement prior to their first surgery. Most patients (8/14) had initial surgeries targeting the temporal lobe. Seizure recurrence ranged from the immediate post-operative period to one year. The main modality used to determine insular involvement was MEG (8/14). Nine patients underwent re-operations that included insular resection; seven achieved a favorable post-operative outcome (Engel I or II). Conclusions: Our series suggests that lowering the threshold for suspecting insular epilepsy may be necessary to improve epilepsy surgery outcomes. Detecting insular epilepsy post-surgery-failure may allow for re-operations which may lead to good outcomes.
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19
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Irannejad A, Chaitanya G, Toth E, Pizarro D, Pati S. Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy. Front Neurol 2022; 12:761412. [PMID: 35095721 PMCID: PMC8793936 DOI: 10.3389/fneur.2021.761412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SOZ for particular electrographic seizure onset patterns. Therefore, using direct cortical stimulation (DCS) as a probing tool to identify seizure generators, we systematically evaluated the causality of the high EI nodes (>0.3) in replicating the patient's habitual seizures. Specifically, we assessed the diagnostic yield of high EI nodes, i.e., the proportion of high EI nodes that evoked habitual seizures. A retrospective single-center study that included post-stereo encephalography (SEEG) confirmed TLE patients (n = 37) that had all high EI nodes stimulated, intending to induce a seizure. We evaluated the nodal responses (true and false responder rate) to stimulation and correlated with electrographic seizure onset patterns (hypersynchronous-HYP and low amplitude fast activity patterns-LAFA) and clinically defined SOZ. The ictogenicity (i.e., the propensity to induce the patient's habitual seizure) of a high EI node was only 44.5%. The LAFA onset pattern had a significantly higher response rate to DCS (i.e., higher evoked seizures). The concordance of an evoked habitual seizure with a clinically defined SOZ with good outcomes was over 50% (p = 0.0025). These results support targeted mapping of SOZ in LAFA onset patterns by performing DCS in high EI nodes to distinguish seizure generators (true responders) from hyperexcitable nodes that may be involved in early propagation.
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Affiliation(s)
- Auriana Irannejad
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Sandipan Pati
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20
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Zhu Z, Zhang Z, Gao X, Feng L, Chen D, Yang Z, Hu S. Individual Brain Metabolic Connectome Indicator Based on Jensen-Shannon Divergence Similarity Estimation Predicts Seizure Outcomes of Temporal Lobe Epilepsy. Front Cell Dev Biol 2022; 9:803800. [PMID: 35310541 PMCID: PMC8926031 DOI: 10.3389/fcell.2021.803800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: We aimed to use an individual metabolic connectome method, the Jensen-Shannon Divergence Similarity Estimation (JSSE), to characterize the aberrant connectivity patterns and topological alterations of the individual-level brain metabolic connectome and predict the long-term surgical outcomes in temporal lobe epilepsy (TLE). Methods: A total of 128 patients with TLE (63 females, 65 males; 25.07 ± 12.01 years) who underwent Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) imaging were enrolled. Patients were classified either as experiencing seizure recurrence (SZR) or seizure free (SZF) at least 1 year after surgery. Each individual's metabolic brain network was ascertained using the proposed JSSE method. We compared the similarity and difference in the JSSE network and its topological measurements between the two groups. The two groups were then classified by combining the information from connection and topological metrics, which was conducted by the multiple kernel support vector machine. The validation was performed using the nested leave-one-out cross-validation strategy to confirm the performance of the methods. Results: With a median follow-up of 33 months, 50% of patients achieved SZF. No relevant differences in clinical features were found between the two groups except age at onset. The proposed JSSE method showed marked degree reductions in IFGoperc.R, ROL. R, IPL. R, and SMG. R; and betweenness reductions in ORBsup.R and IOG. R; meanwhile, it found increases in the degree analysis of CAL. L and PCL. L, and in the betweenness analysis of PreCG.R, IOG. R, PoCG.R, PCL. L and PCL.R. Exploring consensus significant metabolic connections, we observed that the most involved metabolic motor networks were the INS-TPOmid.L, MTG. R-SMG. R, and MTG. R-IPL.R pathways between the two groups, and yielded another detailed individual pathological connectivity in the PHG. R-CAU.L, PHG. R-HIP.L, TPOmid.L-LING.R, TPOmid.L-DCG.R, MOG. R-MTG.R, MOG. R-ANG.R, and IPL. R-IFGoperc.L pathways. These aberrant functional network measures exhibited ideal classification performance in predicting SZF individuals from SZR ones at a sensitivity of 75.00%, a specificity of 92.79%, and an accuracy of 83.59%. Conclusion: The JSSE method indicator can identify abnormal brain networks in predicting an individual's long-term surgical outcome of TLE, thus potentially constituting a clinically applicable imaging biomarker. The results highlight the biological meaning of the estimated individual brain metabolic connectome.
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Affiliation(s)
- Zehua Zhu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhimin Zhang
- Department of Blood Transfusion, XiangYa Hospital, Changsha, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dengming Chen
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, XiangYa Hospital, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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21
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Podkorytova I, Hays R, Perven G, Alick Lindstrom S. Epilepsy surgery in patient with monogenic epilepsy related to SCN8A mutation. Epilepsy Behav Rep 2022; 18:100536. [PMID: 35492509 PMCID: PMC9038545 DOI: 10.1016/j.ebr.2022.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/05/2022] Open
Abstract
This is the first epilepsy surgery report in patient with SCN8A mutation. Stereo-EEG evaluation localized seizure onset to the right hippocampus. Resection led to 1.5-year seizure freedom, then seizures relapsed. Seizure frequency after relapse was significantly lower than preoperatively. Epilepsy surgery reduced seizure burden in patient with SCN8A-related epilepsy.
Epilepsy surgery is superior to prolonged medical therapy in patients with drug-resistant focal epilepsy, but reports on epilepsy surgery outcomes for patients with a genetic etiology are limited, especially in adults. This is the first documented report of a stereoelectroencephalography (SEEG) evaluation and resective surgery outcome in an adult patient with epilepsy related to SCN8A mutation. We describe a patient with epilepsy related to SCN8A mutation which was reported as a variant of uncertain significance at time of his pre-surgical evaluation and reclassified as likely pathogenic about 3 years after resective epilepsy surgery. Most of his pre-surgical evaluation results suggested right temporal lobe epilepsy, but few reported semiological symptoms, ictal SPECT, and neuropsychology results were discordant, and brain MRI was non-lesional. Therefore, SEEG was recommended; ultimately, seizures were localized to the right hippocampus. He was seizure-free for 1.5 years after right anterior temporal lobectomy, then reported three focal to bilateral tonic-clonic (FBTC) seizures in the subsequent 12 months (preoperatively, 6 focal impaired awareness seizures and 4–6 FBTC per year). This case demonstrates that epilepsy surgery reduced seizure burden in a patient with SCN8A-related epilepsy granting him short-term seizure freedom after resection, and then decreased seizure frequency after relapse compared to the preoperative baseline.
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22
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Lee HM, Fadaie F, Gill R, Caldairou B, Sziklas V, Crane J, Hong SJ, Bernhardt BC, Bernasconi A, Bernasconi N. Decomposing MRI phenotypic heterogeneity in epilepsy: a step towards personalized classification. Brain 2021; 145:897-908. [PMID: 34849619 DOI: 10.1093/brain/awab425] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
In drug-resistant temporal lobe epilepsy (TLE), precise predictions of drug response, surgical outcome, and cognitive dysfunction at an individual level remain challenging. A possible explanation may lie in the dominant "one-size-fits-all" group-level analytical approaches that does not allow parsing inter-individual variations along the disease spectrum. Conversely, analyzing inter-patient heterogeneity is increasingly recognized as a step towards person-centered care. Here, we utilized unsupervised machine learning to estimate latent relations (or disease factors) from 3 T multimodal MRI features (cortical thickness, hippocampal volume, FLAIR, T1/FLAIR, diffusion parameters) representing whole-brain patterns of structural pathology in 82 TLE patients. We assessed the specificity of our approach against age- and sex-matched healthy individuals and a cohort of frontal lobe epilepsy patients with histologically-verified focal cortical dysplasia. We identified four latent disease factors variably co-expressed within each patient and characterized by ipsilateral hippocampal microstructural alterations, loss of myelin and atrophy (Factor-1), bilateral paralimbic and hippocampal gliosis (Factor-2), bilateral neocortical atrophy (Factor-3), bilateral white matter microstructural alterations (Factor-4). Bootstrap analysis and parameter variations supported high stability and robustness of these factors. Moreover, they were not expressed in healthy controls and only negligibly in disease controls, supporting specificity. Supervised classifiers trained on latent disease factors could predict patient-specific drug-response in 76 ± 3% and postsurgical seizure outcome in 88 ± 2%, outperforming classifiers that did not operate on latent factor information. Latent factor models predicted inter-patient variability in cognitive dysfunction (verbal IQ: r = 0.40 ± 0.03; memory: r = 0.35 ± 0.03; sequential motor tapping: r = 0.36 ± 0.04), again outperforming baseline learners. Data-driven analysis of disease factors provides a novel appraisal of the continuum of interindividual variability, which is likely determined by multiple interacting pathological processes. Incorporating interindividual variability is likely to improve clinical prognostics.
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Affiliation(s)
- Hyo Min Lee
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Fatemeh Fadaie
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ravnoor Gill
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Viviane Sziklas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Joelle Crane
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Seok-Jun Hong
- Center for Neuroscience Imaging Research Institute for Basic Science, Department of Biomedical Engineering, Sungkyunkwan University Suwon South Korea
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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23
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Li H, Wang Y, Yan G, Sun Y, Tanabe S, Liu CC, Quigg MS, Zhang T. A Bayesian State-Space Approach to Mapping Directional Brain Networks. J Am Stat Assoc 2021. [DOI: 10.1080/01621459.2020.1865985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Huazhang Li
- Department of Statistics, University of Virginia, Charlottesville, VA
| | - Yaotian Wang
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Yinge Sun
- Department of Statistics, University of Virginia, Charlottesville, VA
| | - Seiji Tanabe
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - Chang-Chia Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Mark S. Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA
| | - Tingting Zhang
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA
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24
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Nowak A, Bala A. Occult focal cortical dysplasia may predict poor outcome of surgery for drug-resistant mesial temporal lobe epilepsy. PLoS One 2021; 16:e0257678. [PMID: 34591859 PMCID: PMC8483375 DOI: 10.1371/journal.pone.0257678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. METHODS We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005-2016, and correlated factors associated with seizure relapse. RESULTS At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. CONCLUSIONS The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.
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Affiliation(s)
- Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
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25
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Phan CD, Dang AT, Ton-Nu VA, Nguyen HS, Pham NH. Stereotactic Radiosurgery for Treatment of Operculoinsular Refractory Epilepsy After Incomplete Resection in a Child. Int Med Case Rep J 2021; 14:597-603. [PMID: 34512041 PMCID: PMC8421557 DOI: 10.2147/imcrj.s329878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
A 13-year-old right-handed girl had operculoinsular refractory epilepsy with several seizures per week after temporal lobe epilepsy surgery despite appropriate anticonvulsant therapy. Instead of reoperation, she underwent stereotactic radiosurgery (SRS), which was performed using a linac-based Elekta Axesse SRS machine with a marginal dose of 24 Gy (gross target volume: 6.67 cm3) in one fraction. Post-radiosurgery, she had no clinical or radiological complications. She was maintained on two anti-seizure medications following treatment (valproate and levetiracetam) and was seizure free at the time of this report (during four weeks after SRS). Monthly follow-up was planned for the evaluation of long-term outcomes. SRS may be a safe option for treating intractable focal epilepsy or recurrent epilepsy after surgery failure in children.
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Affiliation(s)
- Canh Duy Phan
- Oncology Center, Hue Central Hospital, Hue City, Vietnam
| | - Anh Tuan Dang
- Neurology Department, National Hospital of Pediatrics, Ha Noi, Vietnam
| | - Van Anh Ton-Nu
- Pediatric Department, Hue University of Medicine and Pharmacy - Hue University, Hue City, Vietnam
| | - Huu Son Nguyen
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
| | - Nhu Hiep Pham
- Oncology Center, Hue Central Hospital, Hue City, Vietnam
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26
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Pototskiy E, Vinokuroff K, Ojeda A, Major CK, Sharma D, Anderson T, Howard K, Borenstein R, Musto AE. Downregulation of CD40L-CD40 attenuates seizure susceptibility and severity of seizures. Sci Rep 2021; 11:17262. [PMID: 34446808 PMCID: PMC8390750 DOI: 10.1038/s41598-021-96760-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/11/2021] [Indexed: 12/04/2022] Open
Abstract
Unregulated neuro-inflammation mediates seizures in temporal lobe epilepsy (TLE). Our aim was to determine the effect of CD40-CD40L activation in experimental seizures. CD40 deficient mice (CD40KO) and control mice (wild type, WT) received pentenyltetrazole (PTZ) or pilocarpine to evaluate seizures and status epilepticus (SE) respectively. In mice, anti-CD40L antibody was administered intranasally before PTZ. Brain samples from human TLE and post-seizure mice were processed to determine CD40-CD40L expression using histological and molecular techniques. CD40 expression was higher in hippocampus from human TLE and in cortical neurons and hippocampal neural terminals after experimental seizures. CD40-CD40L levels increased after seizures in the hippocampus and in the cortex. After SE, CD40L/CD40 levels increased in cortex and showed an upward trend in the hippocampus. CD40KO mice demonstrated reduction in seizure severity and in latency compared to WT mice. Anti-CD40L antibody limited seizure susceptibility and seizure severity. CD40L-CD40 interaction can serve as a target for an immuno-therapy for TLE.
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Affiliation(s)
- Esther Pototskiy
- Department of Pathology and Anatomy, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA
| | | | - Andrew Ojeda
- Department of Pathology and Anatomy, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA
| | | | | | | | | | - Ronen Borenstein
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Alberto E Musto
- Department of Pathology and Anatomy, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA.
- Department of Neurology, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA.
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Chen X, Wang Y, Kopetzky SJ, Butz-Ostendorf M, Kaiser M. Connectivity within regions characterizes epilepsy duration and treatment outcome. Hum Brain Mapp 2021; 42:3777-3791. [PMID: 33973688 PMCID: PMC8288103 DOI: 10.1002/hbm.25464] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/11/2022] Open
Abstract
Finding clear connectome biomarkers for temporal lobe epilepsy (TLE) patients, in particular at early disease stages, remains a challenge. Currently, the whole-brain structural connectomes are analyzed based on coarse parcellations (up to 1,000 nodes). However, such global parcellation-based connectomes may be unsuitable for detecting more localized changes in patients. Here, we use a high-resolution network (~50,000-nodes overall) to identify changes at the local level (within brain regions) and test its relation with duration and surgical outcome. Patients with TLE (n = 33) and age-, sex-matched healthy subjects (n = 36) underwent high-resolution (~50,000 nodes) structural network construction based on deterministic tracking of diffusion tensor imaging. Nodes were allocated to 68 cortical regions according to the Desikan-Killany atlas. The connectivity within regions was then used to predict surgical outcome. MRI processing, network reconstruction, and visualization of network changes were integrated into the NICARA (https://nicara.eu). Lower clustering coefficient and higher edge density were found for local connectivity within regions in patients, but were absent for the global network between regions (68 cortical regions). Local connectivity changes, in terms of the number of changed regions and the magnitude of changes, increased with disease duration. Local connectivity yielded a better surgical outcome prediction (Mean value: 95.39% accuracy, 92.76% sensitivity, and 100% specificity) than global connectivity. Connectivity within regions, compared to structural connectivity between brain regions, can be a more efficient biomarker for epilepsy assessment and surgery outcome prediction of medically intractable TLE.
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Affiliation(s)
- Xue Chen
- College of Control Science and Engineering, China University of Petroleum (East China), Qingdao, China.,School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Yanjiang Wang
- College of Control Science and Engineering, China University of Petroleum (East China), Qingdao, China
| | - Sebastian J Kopetzky
- Biomax Informatics AG, Brain Science, Planegg, Germany.,TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | | | - Marcus Kaiser
- School of Computing, Newcastle University, Newcastle upon Tyne, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Andrade-Machado R, Benjumea Cuartas V, Muhammad IK. Recognition of interictal and ictal discharges on EEG. Focal vs generalized epilepsy. Epilepsy Behav 2021; 117:107830. [PMID: 33639439 DOI: 10.1016/j.yebeh.2021.107830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The differentiation between focal and generalized epilepsies based on clinical and electroencephalographic features is difficult and sometimes confusing. OBJECTIVE To review the EEG findings in patients with focal epilepsy. METHODS An extensive literature review was done. We used the following Pubmed and Medline descriptors alone and in different combinations for database searching: focal, partial, epilepsy, electroencephalographic findings, and EEG. Additional filters included review, original articles, and language limited to Spanish and English. Using the above criteria, a total of 69 articles showed the interictal and ictal EEG findings in focal epilepsy. DEVELOPMENT Focal epileptiform discharges and persistence of focal abnormalities, characterize the interictal EEG findings in focal epilepsies. To distinguish SBS from primary generalized spike waves are required to note: (a) a lead-in time of at least 2 s, (b) the morphology of the focal triggering spikes clearly differ from that of the bisynchronous epileptiform paroxysms, and (c) the morphology of triggering spikes resemble that of other focal spikes from the same region. Focal and Generalized Epilepsy can coexist. Delayed Lateralization on EEG with inconclusive onset and bizarre semiology confusing semiology should not be confused with generalized onset seizures with focal evolution. CONCLUSIONS A close attention to localization and morphology of epileptiform discharges, the correct interpretation of secondary bilateral synchrony, and provocative maneuvers help to correctly identify the EEG findings leading to diagnose focal epilepsies. The presence of generalized epileptiform activity does not rule out the existence of a focal epilepsy.
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Perven G, Podkorytova I, Ding K, Agostini M, Alick S, Das R, Dave H, Dieppa M, Doyle A, Harvey J, Lega B, Zepeda R, Hays R. Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation. Epilepsy Behav Rep 2021; 15:100441. [PMID: 33898964 PMCID: PMC8058515 DOI: 10.1016/j.ebr.2021.100441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 01/04/2023] Open
Abstract
Bilateral ictal onsets may lead to surgery failure in mesial temporal lobe epilepsy. Bitemporal SEEG seizures were recorded despite of unilateral non-invasive tests. Patients with non-lesional MTLE need bitemporal invasive evaluation before resection.
Purpose Mesial temporal lobe epilepsy (MTLE) usually responds well to surgical treatment, although in non-lesional cases up to 50% of patients experience seizure relapse. The possibility of bilateral independent seizure onset should be considered as a reason for epilepsy surgery failure. Methods In a cohort of 177 patients who underwent invasive presurgical evaluation with stereo-tactically placed electrodes in two level four epilepsy centers, 29 had non-lesional MTLE. Invasive evaluation results are described. Results Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite of unilateral non-invasive evaluation data. Three of these patients were treated with bitemporal responsive neurostimulator system (RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy. Conclusion We propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulaiton could be an initial treatment option for patients with independent bitemporal seizure onset.
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Affiliation(s)
- Ghazala Perven
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Irina Podkorytova
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Mark Agostini
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Sasha Alick
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Rohit Das
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Hina Dave
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Marisara Dieppa
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Alexander Doyle
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Jay Harvey
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Bradley Lega
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA.,Department of Neurosurgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8855, USA
| | - Rodrigo Zepeda
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
| | - Ryan Hays
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8508, USA
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Bjellvi J, Edelvik Tranberg A, Rydenhag B, Malmgren K. Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study. Neurosurgery 2021; 87:704-711. [PMID: 31792497 PMCID: PMC7490157 DOI: 10.1093/neuros/nyz488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/02/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery. OBJECTIVE To analyze potential risk factors for these outcomes in a large cohort. METHODS We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015. RESULTS Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P = .001) and so too for new-onset TCS (6.7% vs 3.2%; P = .017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01). CONCLUSION Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.
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Affiliation(s)
- Johan Bjellvi
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Edelvik Tranberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tang Y, Liao G, Li J, Long T, Li Y, Feng L, Chen D, Tang B, Hu S. FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy. Front Med (Lausanne) 2020; 7:605002. [PMID: 33425950 PMCID: PMC7793721 DOI: 10.3389/fmed.2020.605002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients. Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized. Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm3; p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm3; p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm3; p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR. Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation.
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Affiliation(s)
- Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Guang Liao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tingting Long
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yulai Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dengming Chen
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Borger V, Schneider M, Taube J, Potthoff AL, Keil VC, Hamed M, Aydin G, Ilic I, Solymosi L, Elger CE, Güresir E, Fimmers R, Schuss P, Helmstaedter C, Surges R, Vatter H. Resection of piriform cortex predicts seizure freedom in temporal lobe epilepsy. Ann Clin Transl Neurol 2020; 8:177-189. [PMID: 33263942 PMCID: PMC7818082 DOI: 10.1002/acn3.51263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022] Open
Abstract
Objective Transsylvian selective amygdalo‐hippocampectomy (tsSAHE) represents a generally recognized surgical procedure for drug‐resistant mesial temporal lobe epilepsy (mTLE). Although postoperative seizure freedom can be achieved in about 70% of tsSAHE, there is a considerable amount of patients with persisting postoperative seizures. This might partly be explained by differing extents of resection of various tsSAHE target volumes. In this study we analyzed the resected proportions of hippocampus, amygdala as well as piriform cortex in regard of postoperative seizure outcome. Methods Between 2012 and 2017, 82 of 103 patients with mTLE who underwent tsSAHE at the authors’ institution were included in the analysis. Resected proportions of hippocampus, amygdala and temporal piriform cortex as target structures of tsSAHE were volumetrically assessed and stratified according to favorable (International League Against Epilepsy (ILAE) class 1) and unfavorable (ILAE class 2–6) seizure outcome. Results Patients with favorable seizure outcome revealed a significantly larger proportion of resected temporal piriform cortex volumes compared to patients with unfavorable seizure outcome (median resected proportional volumes were 51% (IQR 42–61) versus (vs.) 13 (IQR 11–18), P = 0.0001). Resected proportions of hippocampus and amygdala did not significantly differ for these groups (hippocampus: 81% (IQR 73–88) vs. 80% (IQR 74–92) (P = 0.7); amygdala: 100% (IQR 100–100) vs. 100% (IQR 100–100) (P = 0.7)). Interpretation These results strongly suggest temporal piriform cortex to constitute a key target resection volume to achieve seizure freedom following tsSAHE.
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Affiliation(s)
- Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Julia Taube
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Vera C Keil
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Gülsah Aydin
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Yang J, Sawan M. From Seizure Detection to Smart and Fully Embedded Seizure Prediction Engine: A Review. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:1008-1023. [PMID: 32822304 DOI: 10.1109/tbcas.2020.3018465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent review papers have investigated seizure prediction, creating the possibility of preempting epileptic seizures. Correct seizure prediction can significantly improve the standard of living for the majority of epileptic patients, as the unpredictability of seizures is a major concern for them. Today, the development of algorithms, particularly in the field of machine learning, enables reliable and accurate seizure prediction using desktop computers. However, despite extensive research effort being devoted to developing seizure detection integrated circuits (ICs), dedicated seizure prediction ICs have not been developed yet. We believe that interdisciplinary study of system architecture, analog and digital ICs, and machine learning algorithms can promote the translation of scientific theory to a more realistic intelligent, integrated, and low-power system that can truly improve the standard of living for epileptic patients. This review explores topics ranging from signal acquisition analog circuits to classification algorithms and dedicated digital signal processing circuits for detection and prediction purposes, to provide a comprehensive and useful guideline for the construction, implementation and optimization of wearable and integrated smart seizure prediction systems.
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Mazrooyisebdani M, Nair VA, Garcia-Ramos C, Mohanty R, Meyerand E, Hermann B, Prabhakaran V, Ahmed R. Graph Theory Analysis of Functional Connectivity Combined with Machine Learning Approaches Demonstrates Widespread Network Differences and Predicts Clinical Variables in Temporal Lobe Epilepsy. Brain Connect 2020; 10:39-50. [PMID: 31984759 DOI: 10.1089/brain.2019.0702] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Understanding how global brain networks are affected in epilepsy may elucidate the pathogenesis of seizures and its accompanying neurobehavioral comorbidities. We investigated functional changes within neural networks in temporal lobe epilepsy (TLE) using graph theory analysis of resting-state connectivity. Twenty-seven TLE presurgical patients (age 41.0 ± 12.3 years) and 85 age, gender, and handedness equivalent healthy controls (HCs; age 39.7 ± 16.9 years) were enrolled. Eyes-closed resting-state functional magnetic resonance image scans were analyzed to compare network properties and functional connectivity (FC) changes. TLE subjects showed significantly higher global efficiency, lower clustering coefficient ratio, and lower shortest path lengths ratio than HCs, as an indication of a more synchronized, yet less segregated network. A trend of functional reorganization with a shift of network hubs to the contralateral hemisphere was noted in TLE subjects. Support vector machine (SVM) with linear kernel was trained to separate between neural networks in TLE and HC subjects based on graph measurements. SVM analysis allowed separation between TLE and HC networks with 80.66% accuracy using eight features of graph measurements. Support vector regression (SVR) was used to predict neurocognitive performance from graph metrics. An SVR linear predictor showed discriminative prediction accuracy for four key neurocognitive variables in TLE (absolute R value range: 0.61-0.75). Despite TLE, our results showed both local and global network topology differences that reflect widespread alterations in FC in TLE. Network differences are discriminative between TLE and HCs using data-driven analysis and predicted severity of neurocognitive sequelae in our cohort.
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Affiliation(s)
- Mohsen Mazrooyisebdani
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Camille Garcia-Ramos
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rosaleena Mohanty
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elizabeth Meyerand
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Neuroscience Training Program, and University of Wisconsin-Madison, Madison, Wisconsin
| | - Raheel Ahmed
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Hwang BY, Mampre D, Kang JY, Krauss G, Anderson WS. Laser interstitial thermal therapy after failed anterior temporal lobectomy and amygdalohippocampectomy can improve seizure outcome. Epilepsy Behav Rep 2020; 14:100366. [PMID: 32518903 PMCID: PMC7270537 DOI: 10.1016/j.ebr.2020.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Anterior temporal lobectomy and amygdalohippocampectomy (ATL) is the gold standard surgical treatment for drug resistant mesial temporal lobe epilepsy (mTLE). Nevertheless, seizure recurrence after ATL is not uncommon. Insufficient resection of the mesial temporal structures remains one of the most common reasons for ATL failure. Extending the resection leads to improved seizure outcome in a majority of patients. However, repeat craniotomy can be higher risk for the patient and also can be technically challenging due to scarring and altered anatomy. Laser interstitial thermal therapy (LITT) is a novel minimally invasive alternative to ATL, and it has been shown to be safe and effective. However, it is unclear if LITT has a role in managing post-ATL mTLE patients with recurrent seizures and residual epileptogenic structures. LITT is an attractive option for post-ATL patients with residual mesial structures because the surgery is minimally invasive, and it allows precise targeting and real time confirmation of tissue ablation under MRI guidance. We present a case of an mTLE patient with recurrent seizures after ATL who achieved long-term seizure-freedom after successfully undergoing LITT to ablate the residual hippocampus. This approach, if demonstrated to be safe, effective and durable, can benefit select post-ATL mTLE patients. Persistent seizures at long-term follow-up after anterior temporal lobectomy (ATL) is not uncommon. Residual mesial temporal lobe is one of the most common reasons for seizure recurrence after ATL. Laser interstitial thermal therapy (LITT) is a minimally invasive surgery with advantages of intraoperative MRI guidance. LITT can be used to selectively ablate residual mesial temporal structures in post-ATL patients with recurrent seizures.
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Affiliation(s)
- Brian Y Hwang
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Mampre
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory Krauss
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - William S Anderson
- Division of Functional Neurosurgery, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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The Sodium Channel B4-Subunits are Dysregulated in Temporal Lobe Epilepsy Drug-Resistant Patients. Int J Mol Sci 2020; 21:ijms21082955. [PMID: 32331418 PMCID: PMC7216270 DOI: 10.3390/ijms21082955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 01/09/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common type of partial epilepsy referred for surgery due to antiepileptic drug (AED) resistance. A common molecular target for many of these drugs is the voltage-gated sodium channel (VGSC). The VGSC consists of four domains of pore-forming α-subunits and two auxiliary β-subunits, several of which have been well studied in epileptic conditions. However, despite the β4-subunits' role having been reported in some neurological conditions, there is little research investigating its potential significance in epilepsy. Therefore, the purpose of this work was to assess the role of SCN4β in epilepsy by using a combination of molecular and bioinformatics approaches. We first demonstrated that there was a reduction in the relative expression of SCN4B in the drug-resistant TLE patients compared to non-epileptic control specimens, both at the mRNA and protein levels. By analyzing a co-expression network in the neighborhood of SCN4B we then discovered a linkage between the expression of this gene and K+ channels activated by Ca2+, or K+ two-pore domain channels. Our approach also inferred several potential effector functions linked to variation in the expression of SCN4B. These observations support the hypothesis that SCN4B is a key factor in AED-resistant TLE, which could help direct both the drug selection of TLE treatments and the development of future AEDs.
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Wang W, Zhou Q, Zhang X, Li L, Xu C, Piao Y, Wu S, Wang Y, Du W, Zhao Z, Lin Y, Wang Y. Pilot Study of Voxel-Based Morphometric MRI Post-processing in Patients With Non-lesional Operculoinsular Epilepsy. Front Neurol 2020; 11:177. [PMID: 32265823 PMCID: PMC7096577 DOI: 10.3389/fneur.2020.00177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study was to use voxel-based MRI post-processing in detection of subtle FCD in drug-resistant operculoinsular epilepsy patients with negative presurgical MRI, and by combining magnetoencephalography (MEG) to improve the localization of epileptogenic zone. Methods: Operculoinsular epilepsy patients with a negative presurgical MRI were included in this study. MRI post-processing was performed using a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI. Clinical information including semiology, MEG, scalp electroencephalogram (EEG), intracranial EEG and surgical strategy was retrospectively reviewed. The pertinence of MAP-positive areas was confirmed by surgical outcome and pathology. Results: A total of 20 patients were diagnosed with operculoinsular epilepsy had non-lesional MRI during 2010–2018, of which 11 patients with resective surgeries were included. MEG showed clusters of single equivalent current dipole (SECD) in inferior frontal regions in five patients and temporal-insular/ frontal-temporal-insular/parietal-insular regions in five patients. Four out of 11 patients had positive MAP results. The MAP positive rate was 36.4%. The positive regions were in insular in one patient and operculoinsular regions in three patients. Three of the four patients who were MAP-positive got seizure-free after successfully resect the MAP-positive and MEG-positive regions (the pathology results were FCD IIb in two patients and FCD IIa in one patient). Conclusions: MAP is a useful tool in detection the epileptogenic lesions in patients with MRI-negative operculoinsular epilepsy. Notably, in order to make a right surgical regime decision, MAP results should always be interpreted in the context of the patient's anatomo-electroclinical presentation.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qilin Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Siqi Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yajie Wang
- Department of Pathology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Du
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhilian Zhao
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Andrews JP, Gummadavelli A, Farooque P, Bonito J, Arencibia C, Blumenfeld H, Spencer DD. Association of Seizure Spread With Surgical Failure in Epilepsy. JAMA Neurol 2020; 76:462-469. [PMID: 30508033 DOI: 10.1001/jamaneurol.2018.4316] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. Objective To characterize features of surgically refractory TLE. Design, Setting, and Participants Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015. Thirteen patients were excluded for having less than 1 year of follow-up. Patients at the highest risk for seizure recurrence were identified. Intracranial electroencephalogram (iEEG) analyses generated 3-dimensional seizure spread representations and quantified rapid seizure spread. The final analyses of seizure outcome and follow-up data were performed in June 2017. Main Outcomes and Measures The Engel class seizure outcome following surgery was evaluated for all patients, defining seizure recurrence as Engel class II or greater. Intracranial recordings of neocortical grids/strips and depth electrodes were analyzed visually for seizure spread. Fast β power was projected onto reconstructions of patients' brain magnetic resonance imaging scans to visualize spread patterns and was quantified to compare power within vs outside resective margins. Results Of 118 patients with 1 year of follow-up or more (mean [SD], 6.5 [4.6] years), 66 (55.9%) were women and 52 (44.1%) were men (median age, 39 years [range, 4-66 years]). The cumulative probability of continuous Engel class I seizure freedom since surgery at postoperative year 10 and afterward was 65.6%, with 92% of recurrences in years 1 to 3. Multivariable statistical analyses found that the selection for iEEG study was the most reliable predictor of seizure recurrence, with a mixed-effects model estimating that the Engel score in the iEEG cohort was higher by a mean (SD) of 1.1 (0.33) (P = .001). In patients with iEEG results, rapid seizure spread in less than 10 seconds was associated with recurrence (hazard ratio, 5.99; 95% CI, 1.7-21.1; P < .01). In the first 10 seconds of seizures, fast β power activity outside the resective margins in the lateral temporal cortex was significantly greater in patients whose seizures recurred compared with patients who were seizure-free (mean [SEM], 137.5% [16.8%] vs 93.4% [4.6%]; P < .05). Conclusions and significance Rapid seizure spread outside anteromedial temporal resection resective margins plays a significant role in the surgical failure of drug-resistant TLE. Seizure control after epilepsy surgery might be improved by investigating areas of early spread as candidates for resection or neuromodulation.
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Affiliation(s)
- John P Andrews
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Pue Farooque
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Bonito
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Hal Blumenfeld
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis D Spencer
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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DeSalvo MN, Tanaka N, Douw L, Cole AJ, Stufflebeam SM. Contralateral Preoperative Resting-State Functional MRI Network Integration Is Associated with Surgical Outcome in Temporal Lobe Epilepsy. Radiology 2020; 294:622-627. [PMID: 31961245 DOI: 10.1148/radiol.2020191008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Although most patients with medically refractory temporal lobe epilepsy (TLE) experience seizure freedom after anterior temporal lobectomy, approximately 40% may continue to have seizures. Functional network integration, as measured with preoperative resting-state functional MRI, may help stratify patients who are more likely to experience postoperative seizure freedom. Purpose To relate preoperative resting-state functional MRI and surgical outcome in patients with medically refractory TLE. Materials and Methods Data from patients with medically intractable TLE were retrospectively analyzed. Patients underwent preoperative resting-state functional MRI between March 2010 and April 2013 and subsequent unilateral anterior temporal lobectomy. Postoperative seizure-free status was categorized using the Engel Epilepsy Surgery Outcome Scale. Global and regional resting-state functional MRI network properties on preoperative functional MRI scans related to integration were calculated and statistically compared between patients who experienced complete postoperative seizure freedom (Engel class IA) and all others (Engel class IB to class IV) using t tests and multiple logistic regression. Results Forty patients (mean age, 34 years ± 15 [standard deviation]; 21 female) were evaluated. Preoperative global network integration was different (P = .01) between patients who experienced seizure freedom after surgery and all other patients, with 9% lower leaf fraction and 10% lower tree hierarchy in patients with ongoing seizures. Preoperative regional network integration in the contralateral temporoinsular region was different (P = .04) between patients in these two groups. Specifically, the group-level leaf proportion was 59% lower in the entorhinal cortex, 73% lower in the inferior temporal gyrus, 43% lower in the temporal pole, and 69% lower in the insula in patients with ongoing seizures after surgery. When using multivariate regression, contralateral temporoinsular leaf proportion (P = .002) and epilepsy duration (P = .04) were predictive of postoperative seizure freedom, while age (P > .70) and age at seizure onset (P > .50) were not. Conclusion Lower network integration globally and involving the contralateral temporoinsular cortex on preoperative resting-state functional MRI scans is associated with ongoing postoperative seizures in patients with temporal lobe epilepsy. © RSNA, 2020.
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Affiliation(s)
- Matthew N DeSalvo
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Naoaki Tanaka
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Linda Douw
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Andrew J Cole
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
| | - Steven M Stufflebeam
- From the Athinoula A. Martinos Center for Biomedical Imaging, 149 13th St, Suite 2301, Charlestown, MA 02129 (M.N.D., N.T., L.D., S.M.S.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.N.D., A.J.C., S.M.S.); Sapporo Neuroimaging Research Group, Sapporo, Japan (N.T.); and Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (L.D.)
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Neuronal network remodeling and Wnt pathway dysregulation in the intra-hippocampal kainate mouse model of temporal lobe epilepsy. PLoS One 2019; 14:e0215789. [PMID: 31596871 PMCID: PMC6785072 DOI: 10.1371/journal.pone.0215789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/20/2019] [Indexed: 01/19/2023] Open
Abstract
Mouse models of mesial temporal lobe epilepsy recapitulate aspects of human epilepsy, which is characterized by neuronal network remodeling in the hippocampal dentate gyrus. Observational studies suggest that this remodeling is associated with altered Wnt pathway signaling, although this has not been experimentally examined. We used the well-characterized mouse intrahippocampal kainate model of temporal lobe epilepsy to examine associations between hippocampal neurogenesis and altered Wnt signaling after seizure induction. Tissue was analyzed using immunohistochemistry and confocal microscopy, and gene expression analysis was performed by RT-qPCR on RNA extracted from anatomically micro-dissected dentate gyri. Seizures increased neurogenesis and dendritic arborization of newborn hippocampal dentate granule cells in peri-ictal regions, and decreased neurogenesis in the ictal zone, 2-weeks after kainate injection. Interestingly, administration of the novel canonical Wnt pathway inhibitor XAV939 daily for 2-weeks after kainate injection further increased dendritic arborization in peri-ictal regions after seizure, without an effect on baseline neurogenesis in control animals. Transcriptome analysis of dentate gyri demonstrated significant canonical Wnt gene dysregulation in kainate-injected mice across all regions for Wnt3, 5a and 9a. Intriguingly, certain Wnt genes demonstrated differential patterns of dysregulation between the ictal and peri-ictal zones, most notably Wnt5B, 7B and DKK-1. Together, these results demonstrate regional variation in Wnt pathway dysregulation early after seizure induction, and surprisingly, suggest that some Wnt-mediated effects might actually temper aberrant neurogenesis after seizures. The Wnt pathway may therefore provide suitable targets for novel therapies that prevent network remodeling and the development of epileptic foci in high-risk patients.
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The role of magnetoencephalography in the presurgical evaluation of patients with MRI-negative operculo-insular epilepsy. Seizure 2018; 61:104-110. [DOI: 10.1016/j.seizure.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/30/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022] Open
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Luan L, Sun Y, Yang K. Surgical strategy for temporal lobe epilepsy with dual pathology and incomplete evidence from EEG and neuroimaging. Exp Ther Med 2018; 16:4886-4892. [PMID: 30546403 DOI: 10.3892/etm.2018.6774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/02/2018] [Indexed: 11/06/2022] Open
Abstract
Coexistence of hippocampal sclerosis (HS) and a temporal neocortical lesion, including focal cortical dysplasia, vascular malformations or benign primary brain tumors, is defined as dual pathology. In the majority of cases, the complete evidence based on electroencephalogram (EEG) and magnetic resonance imaging (MRI) for each of the dual pathological lesions is difficult to obtain. As a result, patients with dual pathology are poor surgical candidates due to potential incomplete resection of the epileptogenic zone. The current study retrospectively reviewed 24 patients with potential dual pathology and incomplete EEG and MRI evidence, aiming to provide novel surgical strategies. The results revealed a significantly worse seizure-free outcome for patients with incomplete EEG and MRI data compared with patients who received a clear diagnosis of dual pathology based on complete test results (11.1 vs. 60.0%; P<0.05). Notably, satisfying surgical (seizure-free) outcomes were still achieved in 60% of patients with unclear EEGs to locate the onset zone and clear MRI scans identifying the sclerotic hippocampus and nearby neocortical lesions, which could be resected together. In patients with multiple epileptogenic onsets or with widespread epileptic discharges, the hippocampus should be spared from resection due to concern for potential postsurgical mood or memory disorders. In conclusion, patients with resection of the sclerotic hippocampus and neocortical lesion had improved seizure-free outcomes compared with patients who received individual lesion resection. The current study aimed to provide a novel surgical strategy for neurosurgeons treating epileptic patients with dual pathology.
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Affiliation(s)
- Lan Luan
- Department of Neurosurgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Yuqiang Sun
- Department of Neurosurgery, The Central Hospital of Harbin, Harbin, Heilongjiang 150000, P.R. China
| | - Kang Yang
- Department of Neurosurgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
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Abstract
Temporal lobe epilepsy (TLE) surgery is the most common type of surgical treatment offered to patients with drug-resistant focal seizures. However, the proportion of patients experiencing long-term freedom from seizures after TLE surgery remains suboptimal. Temporal plus epilepsy, which is characterized by a primary temporal epileptogenic zone extending to neighboring regions, has been demonstrated to be a major predictor of TLE surgery failures. In the context of the temporoperisylvian epilepsies, i.e., the most common type of temporal plus epilepsy, a possible role of the insula has often been hypothesized. As this area is buried deep within the lateral sulcus, the use of invasive recordings is often required. Identifying patients with temporal plus seizures is a relevant issue, as they appear to have a worse postsurgical seizure outcome compared with patients with "pure" temporal lobe seizures. Owing to these prognostic implications, it becomes important to identify, among patients suffering from "atypical" nonlesional TLEs, those who should undergo invasive investigations, in particular to explore the insula. In fact, only a primary involvement of the insula in the epileptogenic network may require to include this area in the resection to achieve seizure freedom. Using modern neurosurgical techniques, insular epilepsy surgery has proved to be safe and beneficial, making the "true" role of the insula in TLE surgery failures more relevant to understand. Further studies are needed to evaluate the efficacy of multilobar resections in patients with temporal plus epilepsy, in particular, when eloquent or difficult to access areas such as insula are suspected to be involved.
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Janz P, Hauser P, Heining K, Nestel S, Kirsch M, Egert U, Haas CA. Position- and Time-Dependent Arc Expression Links Neuronal Activity to Synaptic Plasticity During Epileptogenesis. Front Cell Neurosci 2018; 12:244. [PMID: 30154698 PMCID: PMC6102356 DOI: 10.3389/fncel.2018.00244] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
In mesial temporal lobe epilepsy (mTLE) an initial precipitating injury can trigger aberrant wiring of neuronal circuits causing seizure activity. While circuit reorganization is known to be largely activity-dependent, the interactions between neuronal activity and synaptic plasticity during the development of mTLE remain poorly understood. Therefore, the present study aimed at delineating the spatiotemporal relationship between epileptic activity, activity-dependent gene expression and synaptic plasticity during kainic acid-induced epileptogenesis in mice. We show that during epileptogenesis the sclerotic hippocampus differed from non-sclerotic regions by displaying a consistently lower power of paroxysmal discharges. However, the power of these discharges steadily increased during epileptogenesis. This increase was paralleled by the upregulation of the activity-related cytoskeleton protein (Arc) gene expression in dentate granule cells (DGCs) of the sclerotic hippocampus. Importantly, we found that Arc mRNA-upregulating DGCs exhibited increased spine densities and spine sizes, but at the same time decreased AMPA-type glutamate receptor (AMPAR) densities. Finally, we show that in vivo optogenetic stimulation of DGC synapses evoked robust seizure activity in epileptic mice, but failed to induce dendritic translocation of Arc mRNA as under healthy conditions, supporting the theory of a breakdown of the dentate gate in mTLE. We conclude that during epileptogenesis epileptic activity emerges early and persists in the whole hippocampus, however, only the sclerotic part shows modulation of discharge amplitudes accompanied by plasticity of DGCs. In this context, we identified Arc as a putative mediator between seizure activity and synaptic plasticity.
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Affiliation(s)
- Philipp Janz
- Experimental Epilepsy Research, Department of Neurosurgery, University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Pascal Hauser
- Experimental Epilepsy Research, Department of Neurosurgery, University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Katharina Heining
- Faculty of Biology, University of Freiburg, Freiburg, Germany.,Laboratory for Biomicrotechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Sigrun Nestel
- Institute for Anatomy and Cell Biology, Department of Neuroanatomy, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Kirsch
- Institute for Anatomy and Cell Biology, Department of Neuroanatomy, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Ulrich Egert
- Laboratory for Biomicrotechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, University Medical Center, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
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Lee K, Khoo HM, Lina JM, Dubeau F, Gotman J, Grova C. Disruption, emergence and lateralization of brain network hubs in mesial temporal lobe epilepsy. NEUROIMAGE-CLINICAL 2018; 20:71-84. [PMID: 30094158 PMCID: PMC6070692 DOI: 10.1016/j.nicl.2018.06.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/26/2018] [Accepted: 06/27/2018] [Indexed: 01/05/2023]
Abstract
Hubs of brain networks are brain regions exhibiting denser connections than others, promoting long-range communication. Studies suggested the reorganization of hubs in epilepsy. The patterns of connector hub abnormalities specific to mesial temporal lobe epilepsy (mTLE) are unclear. We wish to quantify connector hub abnormalities in mTLE and identify epilepsy-related resting state networks involving abnormal connector hubs. A recently developed sparsity-based analysis of reliable k-hubness (SPARK) allowed us to address this question by using resting state functional MRI in 20 mTLE patients and 17 healthy controls. Handling the multicollinearity of functional networks, SPARK measures a new metric of hubness by counting the number (k) of networks involved in each voxel, and identifies which networks are actually associated to each connector hub. This measure provides new information about the network architecture involving connector hubs and a realistic range of k-hubness. We quantified the disruption and emergence of connector hubs in individual epileptic subjects and assessed the lateralization of networks involving connector hubs. In mTLE, we found pathological disruptions of normal connector hubs in the mTL and within the default mode network. Right mTLE had remarkably higher emergence of new connector hubs in the mTL than left mTLE. Different patterns of lateralization of the salience network involving the abnormal hippocampus were found in right versus left mTLE. The temporal, cerebellar, default mode, subcortical and motor networks also contributed to the lateralization of hippocampal networks. We finally observed an asymmetrical connector hub reorganization and overall regularization of epilepsy-related resting state networks in mTLE, characterized by the disruption of distant connections and the emergence of local connections. Individually reproducible brain network hubs in mesial Temporal Lobe Epilepsy (mTLE). We observed asymmetrical connector hub reorganization and network regularization in mTLE. We found connector hub disruptions within the mTL and default mode network. Emergence of new connector hubs in the mTL was prominent in right but not in left mTLE. Lateralization of hippocampal connectivity was associated with the salience network.
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Affiliation(s)
- Kangjoo Lee
- Multimodal Functional Imaging Lab, Department of Biomedical Engineering, McGill University, Duff Medical Building, 3775 Rue University, Montreal, QC H3A 2B4, Canada; Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC H3A 2B4, Canada.
| | - Hui Ming Khoo
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC H3A 2B4, Canada; Department of Neurosurgery, Osaka University, 2-2 Yamadaoka, Suita, Osaka Prefecture, 565-0871, Japan
| | - Jean-Marc Lina
- École de Technologie Supérieure, 1100 Rue Notre-Dame O, Montreal, QC H3C 1K3, Canada; Centre de Recherches Mathématiques, Université de Montréal, Pavillon André-Aisenstadt 2920 Chemin de la tour, Montreal, QC H3T 1J4, Canada
| | - François Dubeau
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC H3A 2B4, Canada
| | - Jean Gotman
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC H3A 2B4, Canada
| | - Christophe Grova
- Multimodal Functional Imaging Lab, Department of Biomedical Engineering, McGill University, Duff Medical Building, 3775 Rue University, Montreal, QC H3A 2B4, Canada; Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC H3A 2B4, Canada; Centre de Recherches Mathématiques, Université de Montréal, Pavillon André-Aisenstadt 2920 Chemin de la tour, Montreal, QC H3T 1J4, Canada; Department of Physics and PERFORM Centre, Concordia University, 7200 Rue Sherbrooke St. W, Montreal, QC H4B 1R6, Canada
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Moles A, Guénot M, Rheims S, Berthiller J, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Bourdillon P. SEEG-guided radiofrequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy. J Neurol 2018; 265:1998-2004. [DOI: 10.1007/s00415-018-8958-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Singhal NS, Numis AL, Lee MB, Chang EF, Sullivan JE, Auguste KI, Rao VR. Responsive neurostimulation for treatment of pediatric drug-resistant epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:21-24. [PMID: 30013930 PMCID: PMC6019859 DOI: 10.1016/j.ebcr.2018.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 01/26/2018] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
Abstract
Responsive neurostimulation for epilepsy involves an implanted device that delivers direct electrical brain stimulation in response to detection of incipient seizures. Responsive neurostimulation is a safe and effective treatment for adults with drug-resistant epilepsy, but although novel treatments are critically needed for younger patients, responsive neurostimulation is currently not approved for children with drug-resistant epilepsy. Here, we report a 16-year-old patient with seizures arising from eloquent cortex, who was successfully treated with responsive neurostimulation. This case highlights the potential utility of this therapy for pediatric patients and underscores the need for larger studies.
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Affiliation(s)
- Nilika S Singhal
- Department of Neurology, University of California, San Francisco, USA
| | - Adam L Numis
- Department of Neurology, University of California, San Francisco, USA
| | - Morgan B Lee
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Joseph E Sullivan
- Department of Neurology, University of California, San Francisco, USA
| | - Kurtis I Auguste
- Department of Neurosurgery, University of California, San Francisco, USA
| | - Vikram R Rao
- Department of Neurology, University of California, San Francisco, USA
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Vassileva A, van Blooijs D, Leijten F, Huiskamp G. Neocortical electrical stimulation for epilepsy: Closed-loop versus open-loop. Epilepsy Res 2018; 141:95-101. [DOI: 10.1016/j.eplepsyres.2018.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 11/15/2017] [Accepted: 02/16/2018] [Indexed: 10/18/2022]
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Vorkapić M, Useinović N, Janković M, Hrnčić D. Heart rate variability processing in epilepsy: The role in detection and prediction of seizures and SUDEP. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-18553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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50
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Martinoni M, Marucci G, Gagliardini G, Tinuper P, Michelucci R, Giulioni M. Coexistence of meningoencephalocele and hippocampal sclerosis: a new type of dual pathology. Acta Neurochir (Wien) 2017; 159:767-769. [PMID: 28353003 DOI: 10.1007/s00701-017-3153-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
Both temporal lobe meningoencephalocele (TE) and hippocampal sclerosis (HS) are causes of drug-resistant temporal lobe epilepsy. Spontaneous TE constitutes a rare but well-known and increasingly recognised cause of refractory epilepsy. It is well known that HS may be associated with another neocortical lesion (dual pathology). Here we report for the first time a new type of dual pathology; namely, the coexistence of temporal pole meningoencephalocele and HS.
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Affiliation(s)
- Matteo Martinoni
- Neurosurgery Unit, Department of Neurosciences, NOCSAE Modena Hospital, Via Pietro Giardini, 1355, Baggiovara, 41126, Modena, MO, Italy.
| | - Gianluca Marucci
- Department of Neuropathology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | | | - Paolo Tinuper
- IRCCS-ISNB Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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